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1 <br /> • 0 Chain of Custody Number • <br /> SECOR Chain-of Custody Record q aq S'K <br /> Field Office 077 Sacramento ❑ Additional documents are attached,and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store#20832 <br /> Rancho Cordova,CA Location 4627 Da Vinci Drive <br /> Stockton,California <br /> Protect# 77EL 20632 04 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlome <br /> 0 <br /> Laboratory Kiff Analytical 00 125 <br /> r <br /> Turnaround Time Standarda 2 .2 1 <br /> W n 803 O9 <br /> Sampler's Name � E a p m <br /> Sampler's Signature m N fag o 3 <br /> 4 Y E e a� eo 4 Comments/ <br /> = 2r = w :9 12 E,r, < E <br /> Sample ID Date Time Matrix m a to m s m cR p u Instructions z' <br /> MW-1 3 Water x X X 3 01 <br /> MW-2 12,110 Water x X X 3 02 <br /> MW-3 IY2- Water x X X 3 Io3 <br /> MW-SR 13D i Water x X X 3 0 L# <br /> MW-5 j o Water x X X 3 05 <br /> MW-6 Water x X X 3 06 <br /> MW-7 Water x X X 3 07 <br /> Special Instructions/Comments Relinquished by Received by Sample Receipt <br /> 5 Oxygenates,TAME, MtBE,EtBE,TBA,$DIPE Sign Sign Total no of containers <br /> Global ID#70607700798(SIRC) Print Print Chain of custody seals <br /> email EDD to dacatlln@secor com Company S��sY- Compan Recd in good oxKhtioNcold <br /> email results to dherzog@secor.com and Time Date z-rte';L Yi Date Conforms to record <br /> tmiller@secor com Relinquished by Received y <br /> Sign Sign Client SECOR <br /> Print Print ^1 ek Client Contact. Tom Miller <br /> Compan Company Client Phone (916)861-0400 <br /> Tim Date Time 1636 Date ik1805 ext 279 i <br /> SECOR«A�ftv Z <br /> Date 2_ -JB-d5_ Page <br />